A Brief History of Department Regulation 83

The No-Fault Fee Schedule Regulation

The Comprehensive Motor Vehicle Insurance Reparations Act, more commonly known
as the New York No-Fault Law, became effective on February 1, 1974. The law was enacted to
provide prompt payment of health related expenses and wage loss of those parties injured as
a result of an auto accident.

There were a number of problems with the first No-Fault law, including abuses
in health provider charges. As a result of such abuses, among the reforms to the No-Fault law
that took effect December 1, 1977 was the implementation of fee schedules to control costs.
These fee schedules govern virtually every health service expenditure payable by No-Fault.

Article 51 of the Insurance Law contains the provisions authorizing the establishment
of a No-Fault reparations system for persons injured in motor vehicle accidents and Section
5108 specifically authorizes the Superintendent to adopt or promulgate fee schedules for health
care benefits payable under the no-fault system.

In order to implement Section 5108, the Superintendent has promulgated
Department Regulation 83. The Superintendent, in Regulation 83, adopted those fee schedules
that are promulgated by the Chair of the Workers Compensation Board and has also established
certain other fee schedules for professional health services for which schedules have not been
established by the Chairman of the Workers
Compensation Board. The fee schedules established by the Superintendent are contained in Appendix
17-C of Regulation 83.

The Workers Compensation Board fee schedules were initially adopted
in 1977 and have been revised regularly since that time in order to reflect inflationary increases
and to incorporate new procedure codes as well as other necessary enhancements. Periodic revision
to these fee schedules is a part of the ongoing process of keeping the fee schedules current
and reflective of changes in the health care industry, thereby facilitating access to health
care for motor vehicle accident victims while controlling costs. Similar modifications and
improvements have also been applied to those fee schedules established by the Department
for various health care services that are not covered in any fee schedule established by the
Workers Compensation Board. Such periodic revisions to the various fee schedules have
been promulgated by the Superintendent through amendments to Regulation 83. There have been
thirty-two amendments to Regulation 83.

The Workers' Compensation Board revised its fee schedules to utilize the American
Medical Association's Current Procedural Terminology (CPT) coding effective on October 1, 1996.
CPT coding is a nationally accepted billing standard that utilizes a 5 digit number to identify
the medical procedure being performed and billed, and provides a description of the procedure
and what the performance of that procedure entails.

It should be noted that although the general instructions and ground rules
in the Workers Compensation Boards medical fee schedules apply to No-Fault claims,
in accordance with the provisions of Regulation 83, those rules which refer to workers compensation
claim forms, preauthorization approval, and dispute resolution guidelines do not apply to No-Fault
claims.

The Official New York Workers' Compensation Medical Fee Schedule may be examined at the office of the Department of State, 162 Washington Ave., Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the Workers' Compensation Board in Albany, Binghamton, Brooklyn, Buffalo, Hauppauge, Hempstead, Manhattan, Peekskill, Queens, Rochester and Syracuse. Copies may be purchased from OptumInsight, by writing to: Official New York Workers' Compensation Medical Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; or by telephone at 1-800-464-3649 (option #1); or online at www.optumcoding.com, Keyword New York or http://www.optumcoding.com/Product/40508/. The price for a hard copy of the New York Medical Fee Schedule is $85.

The complete text of No-Fault Regulations 68 and 83 and No-Fault related frequently
asked questions, as well as select opinions of the Departments Office of General Counsel
applicable to No-Fault coverage may be found at http://www.dfs.ny.gov/insurance/r68_link.htm.